PiCCO技術(shù)在ARDS診斷和治療中的應(yīng)用

1、Case report: 腹痛伴惡心嘔吐腹痛伴惡心嘔吐4天天血常規(guī)： WBC 3.6109/L GRA 25% PLT 35109/L血?dú)猓簆H 7.429 PO2 86.4mmHg (FiO2 50%) 生化： ALB 15g/L CR 330umol/L心電圖：竇性心律, ST-T異常急性呼吸衰竭的病因?Am J Respir Crit Care Med, 1994,149:818-824缺乏反映其病理生理特征的血管通透性指標(biāo)缺乏反映其病理生理特征的血管通透性指標(biāo)對(duì)于有根底心臟病史，合并感染、休克時(shí)鑒別診斷非常困難對(duì)于有根底心臟病史，合并感染、休克時(shí)鑒別診斷非常困難ARDS vs card

2、iogenic pul edema該患者可能因素？該患者可能因素？ Intensive Care Med, 2002,28(8):1073-7N Engl J Med 2006,354:2213-24n 29 pats ：PAWP 18mm Hgn 97% pats with PAWP 18mm Hg had a normal or elevated CI1001 patients, 513 assigned to PAC, 488 to CVCSchuster DP. The search for “objective criteria for ARDS. Intensive Care Me

3、d, 2007, 33:400-402.Ware LB,. Matthay MA. Acute Pulmonary Edema. N Engl J Med, 2005;353:2788-96.Schuster DP, Stark T, Stephenson J, et al. Detecting lung injury in patients with pulmonary edema. Intensive Care Med, 2002, 28: 1246-1253. 肺水指標(biāo)：肺水指標(biāo)： Extravascular Lung Water: EVLW Pulmonary Vascular Per

4、meability Index: PVPI (EVLW/PBV)EVLWi/GEDVi 3.01021.2102 1.41020.4102*Cut-off value = 3 Se=85% Sp=100%Critical Care 2006, 10(Suppl 1):P326 Management of ARDSCrit Care Med. 2004; 32:691699.Crit Care Med 2004; 32:691699n擇期心臟手術(shù)患者n=20n監(jiān)測(cè) GEDVI: PiCCO CEDVIPAC: PAC LV preload assessment: TEEnHemodynamic

5、measurements: before (T0) and 20 min (T1) and 40 min (T2) after a volume loadnVolume load: HES10 ml/kg over 20minBritish Journal of Anaesthesia. 2005, 94 (6): 748755.British Journal of Anaesthesia 94 (6): 74855 (2005)40 patients undergoing elective OPCABGChest 2005, 128:848854nSVV 、 GEDV、ITBV: Cardiac preload Circ Res 1959, 7: 649-57Management of ARDS拔管失敗可能的原因？拔管失敗可能的原因？Manage